News: FY 2021 IPPS proposed rule includes 600 code changes, 3.1% pay increase for acute care hospitals

CMS issued the fiscal year (FY) 2021 Inpatient Prospective Payment Systems (IPPS) proposed rule on Tuesday, May 11. Included is a proposed increase to hospital payment rates, the creation of a new MS-DRG for chimeric antigen receptor T-Cell (CAR-T) therapy, and ICD-10-CM/PCS updates, Revenue Cycle Advisor reported.

CMS will increase operating payment rates by roughly 3.1% for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting Program and are meaningful EHR users. Similarly, the FY 2020 IPPS proposed rule approximated an increase of 3.2% in operating payment rates.

For FY 2021, CMS projects the rate increase together with other proposed changes to IPPS payment policies will increase IPPS operating payments by approximately 2.5%, reported Revenue Cycle Advisor. Proposed changes in uncompensated care payments, new technology add-on payments, and capital payments will decrease IPPS payments by approximately 0.4% according to the proposed rule. CMS therefore estimates a total increase in overall IPPS payments of approximately 1.6%.

Hospitals may be subject to other payment adjustments under the IPPS, including:

• A 1% penalty for the worst-performing quartile under the Hospital-Acquired Condition Reduction Program
• Penalties for excess readmissions, which reflect an adjustment to a hospital’s performance relative to other hospitals with a similar proportion of patients who are dually eligible for Medicare and full-benefit Medicaid 
• Upward and downward adjustments under the Hospital Value-Based Purchasing Program

According to the proposed rule, CMS projects total Medicare spending on inpatient hospital services, including capital, will increase by about $2.07 billion in FY 2021, Revenue Cycle Advisor reported.

CMS is also proposing the creation of a new MS-DRG specifically for cases involving CAR-T therapies. The new payment group would help to predictably compensate hospitals for their costs in delivering necessary care to Medicare beneficiaries and provide payment flexibility for the future as new CAR-T therapies become available, the rule says.

The 2021 IPPS proposed rule includes just shy of 600 ICD-10-CM coding changing, including 490 new codes, 47 revised codes, and 58 deleted codes. This is almost double the 324 proposed changes in the FY 2020 IPPS proposed rule. Despite the increase in code change proposals, the overall proposed rule comes in at about 200 pages shorter than the 2020 proposal.

Proposed ICD-10-CM code additions include:

• Additional D57 codes for more specified sickle-cell anemia
• D89 codes for cytokine release syndrome
• A slew of new codes related to drug use and abuse (including alcohol, opioids, cannabis, sedatives, cocaine, other stimulants, other psychoactive) with F10-F15 and F19 codes
• Expanded list of H18 corneal dystrophy codes
• M05, M06, M08, and M19 codes for both adult and juvenile rheumatoid arthritis and osteoarthritis
• Expanded R51 codes relating to headaches
• Additional S20 codes for injuries to the thorax
• Expanded T40 codes for poisoning, underdosing, and adverse effects of fentanyl, tramadol, and other synthetic narcotics
• Roughly 120 new V00-V06 codes for electric scooter and other micro-mobility pedestrian conveyance injuries

Proposed ICD-10-CM code deletions include:

• Some H18 corneal dystrophy codes because of the proposed expanded additions
• R51 because of proposed specified headache additions
• Some T40 codes for poisoning due to proposed specified additions

Proposed revised ICD-10-CM codes include:

• Z68 codes relating to both adult and pediatric body mass index
• Allergy status Z88 codes

Along with proposed additions, deletions, and revisions to ICD-10-CM codes, the FY 2021 IPPS proposed rule includes changes to CC/MCC designations.

Proposed changes to the MCC list include:

• Addition of the proposed D57 codes for sickle cell anemia
• Addition of U07.1 for COVID-19, which was already implemented on April 1, 2020
• Deletion of A84.8 for other tick-borne viral encephalitis, which was also a proposed ICD-10-CM deletion

Proposed changes to the CC list include:

• Addition of the proposed F10-F15 and F19 codes related to drug use and abuse
• Addition of the proposed T86 codes related to corneal transplants
• Deletions of proposed deleted T86 codes being replaced by more specified codes for corneal transplant complications

CMS invites the public to comment on all proposals. For more information on the rule, see the Federal Register. Comments are due to CMS no later than 5 p.m. eastern on July 10 as CMS is waiving the 60-day delay in the effective date of the final rule and replacing it with a 30-day delay.

Editor’s note: The FY 2021 IPPS proposed rule can be found here. The entire list of proposed changes to the ICD-10-CM/PCS codes are available in tables 6A-6K and 6P.1a-6P.4a of the rule. Revenue Cycle Advisor’s coverage of the proposed rule can be found here.